A vascular necrosis is a well-recognized pathologic entity in orthopedic surgery which most commonly affects the femoral head. Avascular necrosis of the mandibular condyle has been recognized recently, although controversy exists as to the appropriate methods of diagnosis and treatment. We present a discussion of the pathogenesis of avascular necrosis derived from the orthopedic literature and its extrapolation to management of the temporomandibular joint in the form of decompression corticotomy of the condyle by two techniques.